Original Articles
Right atrial size and tricuspid regurgitation severity predict mortality or transplantation in primary pulmonary hypertension

https://doi.org/10.1067/mje.2002.123962Get rights and content

Abstract

Primary pulmonary hypertension (PPH) is a fatal illness. In advanced stages only transplantation is able to increase survival. Echocardiography is useful for the assessment of these patients, but there is limited information about its prognostic value. With this goal, 25 consecutive patients, age: 36.7 ± 12.7 years, were studied and followed up for a mean period of 29 months (range: 0.2-84). Eleven echocardiographic parameters of cardiac anatomy, function, and hemodynamics were assessed. Age and sex were also analyzed. Death and heart-lung transplantation were considered end-points. Thirteen events (Death: 8; transplantation: 5) occurred in the follow-up (11 of 13 in the first year). Kaplan-Meier estimated survival free from transplantation at 5 years was 40% (95% CI: 23%-70%). In the univariate analysis, RAA (HR: 1.1, P = .0004), TR (HR: 2.7, P = .02), and RVET (HR: 0.98, P = .02) showed statistically significant relation with survival free from transplantation. Multivariate analysis showed that RAS (HR: 1.10, 95% CI: 1.04-1.17, P = .001) and TR (HR: 2.52, 95% CI: 1.01-6.3, P = .047) were independent risk factors of transplantation and death. The use of these findings on the management of patients with PPH should be tested in larger studies. (J Am Soc Echocardiogr 2002;15:1160-4.)

Section snippets

Study group

From December 1993 to May 2000, 78 patients with pulmonary hypertension of diverse causes who were considered potential candidates for lung or heart/lung transplantation were prospectively and consecutively studied by the Echocardiography Section at the Institute of Cardiology and Cardiovascular Surgery-Favaloro Foundation. From this population, 25 patients (mean age: 37.6 ± 12.7 years [range: 20-59 years], 19 female [76%] and 6 male [24%]) who fulfilled the following inclusion criteria entered

Echocardiographic data

Complete measurements were obtained in 22 patients. AT, RVET, and AT/RVET were not measured in 1 patient and dP/dt was not estimated in 2 other patients because of suboptimal Doppler spectral signals of RVOT flow and TR, respectively.

Mean values and SD of analyzed parameters are depicted as follows: RV diastolic diameter: 40.92 ± 11.28 mm; LV diastolic diameter: 32.80 ± 7.4 mm; left atrial size: 13.34 ± 4.01 cm2; RAS: 28.24 ± 10.96 cm2; pulmonary artery diameter: 36.76 ± 8.05 mm; AT: 61.88 ±

Discussion

The prognostic value of echocardiographic parameters of cardiac anatomy, function, and hemodynamic state in patients with PPH was prospectively assessed in this study. In the multivariate analysis the RAS and the severity of TR were found to be predictive factors of mayor events (heart/lung transplantation and death) in the analyzed population (25 patients followed up by a mean period of 29 months).

One of the determinants of the RAS is the pressure on the atrium. As previously mentioned, the

Conclusions

RAS and the severity of TR, 2 parameters easily obtained by echocardiography, were predictive variables of survival free from transplantation in patients with PPH. The impact of these findings on the therapeutic management of this fatal illness should be addressed in larger prospective studies.

References (15)

There are more references available in the full text version of this article.

Cited by (169)

  • Global Right Heart Assessment with Speckle-Tracking Imaging Improves the Risk Prediction of a Validated Scoring System in Pulmonary Arterial Hypertension

    2020, Journal of the American Society of Echocardiography
    Citation Excerpt :

    Chronic increase in RV afterload, as in PAH, leads to progressive RV remodeling that in turn influences the RV-RA relationship with RA dysfunction and dilation as the main consequence.26 Right atrial enlargement is a known marker of poor outcome.8 Recently, the study of atrial function by deformation imaging has gained increasing attention.

View all citing articles on Scopus

Reprint requests: Dr Miguel H. Bustamante-Labarta, ICYCC, Fundación Favaloro, Sección Ecocardiografía, Av. Belgrano 1743, CP (1093), Buenos Aires, Argentina (E-mail: [email protected]).

View full text